1. Technical Field
The present invention relates generally to equipment used to deliver fluids to a patient during surgery. Specifically, the present invention is directed to a device for delivering cardioplegia solution during open-heart surgery and other surgical procedures requiring myocardial protection.
2. Background Art
Heart surgery is among the most complex of surgical fields. Because under normal conditions, the heart muscle is in a constant state of motion, special techniques must be used to make the heart sufficiently stationary to allow a surgeon to operate on it. Although some surgical procedures may be performed on a beating heart, the majority of open-heart and closed-heart procedures, including coronary artery bypass surgery, require that the heart be slowed or stopped and the aorta clamped before the cardiac portion of the surgery may begin. In such procedures, external equipment is used to form an extracorporeal circuit in the patient's circulatory system. Electric/mechanical pumps are used to pump the blood to an artificial oxygenator, then back into the patient, so as to temporarily replace the patient's heart and lungs during the procedure. This technique is known as a “cardiopulmonary bypass,” and it allows the surgical team to stop the heart, while still keeping the patient alive.
The heart muscle (myocardium), no less than any other organ of the body, must also be kept alive during the procedure. Indeed, the myocardium has a very low tolerance for ischemia (reduction in blood supply), due to its high oxygen requirements. Thus, special techniques are employed to protect the myocardium during a cardiopulmonary bypass.
Modern surgical teams often use induced cardioplegia to both stop the heart and protect it from the effects of ischemia. A potassium-based cardioplegic solution is infused into the coronary arteries, usually at a low temperature. The potassium infusion causes an immediate cardiac arrest, while the typically low temperature of the solution reduces the heart's rate of oxygen consumption. There are two commonly-employed cardioplegic methods, blood cardioplegia and crystalloid cardioplegia. Blood cardioplegia is a solution that is mixed with oxygenated blood from the extracorporeal circuit. Crystalloid cardioplegic solution is a non-cellular solution with a saline or balanced electrolyte base such as Ringer's solution. Nowadays, cardioplegia may bedelivered through antegrade (that is, directly through the coronary arteries) or retrograde (through the coronary sinus vein) routes.
During cardiopulmonary bypass, both blood and cardioplegia solution must be circulated through the patient's body. Since the heart is no longer available to maintain the patient's circulation, artificial pump means must be employed. The most commonly employed pump is the DeBakey roller pump, which is described in U.S. Pat. No. 2,018,998 (DEBAKEY et al.) Oct. 29, 1935. The DeBakey pump uses a pair of rollers to create a peristaltic action against a flexible tube. Centrifugal pumps are also employed. Both of these types of pumps produce a relatively constant rate of flow.
Recent research, however, suggests that better cardiac perfusion is obtained with a pulsatile flow than with a constant-rate flow. The heart, after all, is a reciprocating pump and delivers a pulsatile flow. A number of designs have been developed to introduce a pulsatile component to extracorporeal circulation. These designs generally fall into two categories. A first category consists of those devices that combine a roller or centrifugal pump with an additional device that periodically compresses the tube through which the blood or cardioplegia flows. Examples of these devices include U.S. Pat. No. 4,116,589 (RISHTON) Sep. 26, 1978, and U.S. Pat. No. 6,620,121 (MCCOTTER) Sep. 16, 2003.
A second category consists of devices in which the pump itself is used to produce a pulsatile flow. In one type of pump, such as that in U.S. Pat. No. 5,702,358, the number of revolutions per minute (RPM) of a centrifugal pump is varied in a periodic fashion to achieve a roughly pulsatile flow. In U.S. Pat. No. 5,300,015 (RUNGE) Apr. 5, 1994, a type of peristaltic pump is described, which achieves a pulsatile flow. Both of these types of designs, however, are limited in their ability to produce a pulsatile flow of desired characteristics while still maintaining a desired average flow rate.
What is needed, therefore, is an apparatus for extracorporeal circulation that produces a significantly pulsatile flow, while still-maintaining a user-specified average flow rate. The present invention provides a solution to this and other problems, and offers other advantages over previous solutions.